To discuss common gait changes in the elderly, outcome measures and intervention strategies
Objectives:
Understand essential requirements for normal locomotion
Discuss gait changes that commonly occur in the elderly population
Provide commonly used outcome measures for gait assessments
Discuss intervention strategies for gait training in the elderly
Essential requirements for normal locomotion:[1]
Progression
Locomotion patterns that move the limbs and trunk in a coordinated and rhythmic fashion towards the desired direction
Ability to initiate, sustain and terminate movement patterns
Postural control
Ability to maintain dynamic stability
Adaptation
Ability to adapt gait to accomplish goals and be successful in a changing environment
Gait changes[1]
Kinematic Analysis
Decreased gait velocity compared to younger adults (118-123 cm/sec versus 150 cm/sec)
Many elderly adults can not walk faster than 1.4m/sec which is the minimal speed required to cross a street safely
Decreased stride length, especially with fast walking
Decreased vertical excursion of the head during gait cycle
Increased lateral movement
Stride width wider in men over 74
Toe out greater in men over 80
Increased stance phase in adults over 65 years old
Decreased swing phase
Decreased hip, knee and ankle flexion as compared to young adults
When researches analyzed these gait changes, they concluded these older adults did not have a pathological gait pattern, but their walking was guarded, resembling someone walking on a slippery surface, possibly with the intention to increase stability
Gait changes in the elderly may be due to impaired postural control an not changes in the step cycle.
Muscle Activation Patterns
Average EMG activity in gastrocnemius, tibialis anterior, biceps femoris, rectus femoris, peroneus longus were higher in older adults compared to younger individuals
Increased activity may be used to improve stability during stance phase of gait
Increased co-contraction increases balance, by increasing joint stiffness
Kinetic Analysis
Decreased power absorption at heel strike
Higher levels of muscle responses and different muscle activation sequences during walking
Decreased power generated by plantar flexors during push-off
Decreased propulsion results in shorter step length, flat-footed heel strike and increased double support time
RCT, divided 26 participants with fall history into balance training or ankle strengthening groups
Balance training included training on a hard floor, maintaining balance on a cushioned ball and training on an unstable platform
Ankle training included strengthening and stretching exercises for muscles around ankle joint
Results showed significant changes in:
Gait velocity, step/stride length in the balance training group
Gait velocity, cadence, step time, cycle time, step/stride length in the ankle training group
Significant change of gait velocity in balance group compared to ankle training group
Conclusion: Balance and ankle strength training can significantly improve gait in older adults. Balance training lead to greater improvements in gait velocity than ankle strength training.
Study summary:[4]
Retrospective study analyzing the efficiency of 5 weeks of virtual reality training to improve gait and mobility in people with history of falls, poor mobility or postural instability
60 participants average age of 72.18 years
Training was 3/week for 5 weeks for 1 hour
Treatment involved walking on a treadmill with virtual obstacle navigation
Results: TUG decreased by 10.3%, 2MWT increased by 9.5%, FSST performance improved by 13%
Conclusion, virtual reality training can be used in the clinic to enhance gait, mobility and balance training in those with gait instability
Study summary:[5]
Meta-analysis analyzing 25 studies
Improved gait speed is associated with improved survival rates
Conclusion:
Progressive resistance training with high intensities is most effective for exercise modality for improving preferred gait speed
Sufficient muscle strength is important for improving gait speed
Exercise with a rhythmic component (music) may possibly train higher cognitive functions that are important for gait
References: 1. Shumway-Cook, Anne, and Marjorie H. Woollacott. Motor Control: Translating Research into Clinical Practice. Philadelphia: Lippincott Williams & Wilkins, 2007. Print. 2. __http://www.rehabmeasures.org/default.aspx__ 3. Choi, Jung-Hyun, and Nyeon-Jun Kim. “The Effects of Balance Training and Ankle Training on the Gait of Elderly People Who Have Fallen.” Journal of Physical Therapy Science 27.1 (2015): 139–142. PMC. Web. 30 May 2016. 4. Shema, Shirley Roth et al "Clinical Experience Using a 5-Week Treadmill Training Program With Virtual Reality to Enhance Gait in an Ambulatory Physical Therapy Service." Physical Therapy 94.9 (2014): 1319-1326. Web.29 May. 2016. 5.Van Abbema, Renske et al. “What Type, or Combination of Exercise Can Improve Preferred Gait Speed in Older Adults? A Meta-Analysis.” BMC Geriatrics 15 (2015): 72. PMC. Web. 30 May 2016.
- To discuss common gait changes in the elderly, outcome measures and intervention strategies
Objectives:Essential requirements for normal locomotion: [1]
Gait changes[1]
[2] __http://www.rehabmeasures.org/default.aspx__
Treatment:
Study summary: [3]
- RCT, divided 26 participants with fall history into balance training or ankle strengthening groups
- Balance training included training on a hard floor, maintaining balance on a cushioned ball and training on an unstable platform
- Ankle training included strengthening and stretching exercises for muscles around ankle joint
- Results showed significant changes in:
- Gait velocity, step/stride length in the balance training group
- Gait velocity, cadence, step time, cycle time, step/stride length in the ankle training group
- Significant change of gait velocity in balance group compared to ankle training group
- Conclusion: Balance and ankle strength training can significantly improve gait in older adults. Balance training lead to greater improvements in gait velocity than ankle strength training.
Study summary: [4]- Retrospective study analyzing the efficiency of 5 weeks of virtual reality training to improve gait and mobility in people with history of falls, poor mobility or postural instability
- 60 participants average age of 72.18 years
- Training was 3/week for 5 weeks for 1 hour
- Treatment involved walking on a treadmill with virtual obstacle navigation
- Results: TUG decreased by 10.3%, 2MWT increased by 9.5%, FSST performance improved by 13%
- Conclusion, virtual reality training can be used in the clinic to enhance gait, mobility and balance training in those with gait instability
Study summary: [5]- Meta-analysis analyzing 25 studies
- Improved gait speed is associated with improved survival rates
- Conclusion:
- Progressive resistance training with high intensities is most effective for exercise modality for improving preferred gait speed
- Sufficient muscle strength is important for improving gait speed
- Exercise with a rhythmic component (music) may possibly train higher cognitive functions that are important for gait
Resources:References:
1. Shumway-Cook, Anne, and Marjorie H. Woollacott. Motor Control: Translating Research into Clinical Practice. Philadelphia: Lippincott Williams & Wilkins, 2007. Print.
2. __http://www.rehabmeasures.org/default.aspx__
3. Choi, Jung-Hyun, and Nyeon-Jun Kim. “The Effects of Balance Training and Ankle Training on the Gait of Elderly People Who Have Fallen.” Journal of Physical Therapy Science 27.1 (2015): 139–142. PMC. Web. 30 May 2016.
4. Shema, Shirley Roth et al "Clinical Experience Using a 5-Week Treadmill Training Program With Virtual Reality to Enhance Gait in an Ambulatory Physical Therapy Service." Physical Therapy 94.9 (2014): 1319-1326. Web.29 May. 2016.
5.Van Abbema, Renske et al. “What Type, or Combination of Exercise Can Improve Preferred Gait Speed in Older Adults? A Meta-Analysis.” BMC Geriatrics 15 (2015): 72. PMC. Web. 30 May 2016.